Provider Demographics
NPI:1134392335
Name:KAUFMAN, NICOLE MARIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 HERGOTT DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3379
Mailing Address - Country:US
Mailing Address - Phone:859-446-2345
Mailing Address - Fax:
Practice Address - Street 1:3124 HERGOTT DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3379
Practice Address - Country:US
Practice Address - Phone:859-446-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012383225100000X
KYPT-005787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist